But in the nine months following that press conference, Seaborn’s health coverage was canceled twice because of the system’s red tape, once when the system added a new form without giving him time to complete it and a second time when he was told he hadn’t verified his income, even though he had never gotten a notice he needed to do so. When he couldn’t find anyone in the state office managing the program to talk, he just gave up. He once saw Pathways as a “blessing.” Now, he said, “I’m done with it.”
Seaborn’s case offers a warning to all the states as they confront new client work requirements similar to Pathways — at least 80 hours a month in a job, enrollment in job training or education, community service, or care for a young child — by the end of 2026.
Launched in July 2023, Pathways was one of Gov. Kemp’s signature programs. “Since I became governor, we’ve worked hard to expand access to care, get more Georgians covered, and lower costs for families,” he said on the program’s launch. Georgians whose income was below the poverty line and who met the work requirements could be put into the Medicaid program. It was an ambitious effort to solve a very big problem. One-third of the state’s residents were below the poverty line but lacked health coverage.
But of the 240,000 Georgians eligible for the program, only 8,077 were enrolled. Some did not meet the work requirements but others, like Seaborn, got caught up in red tape.
Conservatives have long campaigned to require work in exchange for government benefits. GOP Sen. Tommy Tuberville of Alabama said that “it’s just unfortunate you’ve got a lot of freeloaders in this country.” Progressives, however, have charged that the work requirements were simply a way of booting people off the program. The U.S. Congressional Budget Office estimated that 16 million people might lose Medicaid coverage.
The reality is complex. The low enrollment in Georgia’s Pathways program wasn’t because the state was trying to kick people off Medicaid; the program was created to expand Medicaid coverage.
But of those who applied for the program, 22 percent were denied coverage because of administrative hassles, mostly because applicants struggled to navigate the system’s initial requirements. Of those later kicked out of the program, 30 percent lost coverage for procedural reasons, such as problems in filing the right documents at the right times — or, as in Seaborn’s case, not being informed about the documents that needed to be uploaded.
Pathways might have been a public program, but it relied completely on a system designed, built and managed by a private contractor, Deloitte, with a $528 million agreement.
Deloitte had to construct a system in which applicants could prove that their income was below the poverty line. They needed to show that they had worked, or met one of the other standards, for at least 80 hours per month in the preceding period. Then they had to continue to requalify to go on receiving benefits. To do all that, they had to navigate a website and figure out how to identify and upload documents. Instructions often changed. So did the forms. Sometimes, as was the case for Seaborn, they were not notified about the changes.
Many applicants lacked the computer skills to navigate the system, or just gave up. The state’s own analysis, prepared months before Kemp’s press conference, found that “the system architecture lacks flexibility and adaptability, limiting Georgia’s ability to serve its customers efficiently, improve the customer and worker experience across all programs, ensure data security, reduce benefit errors and fraud, and advance the state’s goal of streamlining eligibility.”
Georgia had little choice but to rely on a contractor, and Deloitte is the industry leader in Medicaid. The company was a logical choice — it holds $5 billion in contracts to run all or part of Medicaid systems across the country, covering more than 50 million Medicaid recipients.
But Deloitte’s changes in Georgia kept many in the state uninsured. The sheer complexity of the program’s requirements, the difficulty of designing an IT system to support them, the challenge of making the system easy for applicants to navigate, especially when many might not be tech-savvy, and the problem of making constant updates was a recipe for excluding hundreds of thousands of Georgians from the Pathways program.
Now that all states must meet similar work requirements by the end of 2026, the race for their business is on among contractors. And states are heading for the same challenges that Georgia encountered: finding they have no choice but to rely on private contractors for a signature public program, but falling captive to the IT problems that result. Luke Seaborn’s tale is sure to be repeated thousands of times across the country.
